Introduction: The natural history of idiopathic scoliosis is not well understood. Previous reports focused on characteristics of curve progression pre-defined at 5–6 degrees. However, the absolute curve magnitude at skeletal maturity is more predictive of long-term curve behavior rather than progression of defined magnitude over shorter periods of growth. It is generally agreed that curves < 30 degrees are unlikely to progress after skeletal maturity. Hence, defining factors that influence curve progression to an absolute magnitude of ≥30 degrees at skeletal maturity significantly aids clinical decision-making.

Methods: Of 279 patients with idiopathic scoliosis detected by school screening of 72,699 adolescents, 186 fulfilled the study criteria and were followed up to skeletal maturity. Initial age, gender, pubertal status and initial curve magnitude were used as predictive factors for curve progression to ≥30 degrees at skeletal maturity. Uni and multivariate, logistic regression and receiver operating characteristic (ROC) analysis was performed.

Results: Curve magnitude at first presentation was the most important predictive factor for curve progression to ≥30 degrees at skeletal maturity. An initial curve of 25 degrees had the best ROC of 0.8 with a positive predictive value of 68% and a negative predictive value of 92% for progression to ≥30 degrees at skeletal maturity. The highest risk was a pre-pubertal female < 12 years of age with a Cobb of ≥25 degrees at presentation; with an 82% chance of progression to a Cobb of ≥30 degrees. Probability of progression to ≥30 degrees was defined by 1/(1 + exp (−z)). [z = −3.709 + 0.931(Gender) + 0.825(Puberty) + 3.314(Cobb) + 0.171(Age)].

Conclusions: Initial curve magnitude is the most important independent predictor of long-term curve progression past skeletal maturity. An initial Cobb of 25 degrees is an important threshold. Combined with other factors, we identify patient profiles with high or low risk for progression.

Early operative debridement is a major determinant of mortality in necrotizing fasciitis. However, early recognition is difficult. The aim of our study is to develop a novel scoring system for distinguishing necrotizing fascitis from other soft tissue infections based on routine laboratory findings on admission.

The developmental cohort consisted of 89 consecutive patients with necrotizing fasciitis treated between January 1997 and August 2002. Control patients (n=225) were randomly selected from patients admitted with the diagnosis of cellulitis or abscesses during the same period. Their haematological and biochemical results done on admission were analyzed.

Total white cell count, haemoglobin, sodium, glucose, creatinine and C-reactive protein were selected as predictors. The final constructed model was reliable and discriminated well between patients with necrotizing fascitis from those with other benign soft tissue infections (Area under the receiver-operating characteristic (ROC) curve, 0.98). The LRINEC score was derived from this model and was validated in a separate cohort of patients from a different hospital (56 patients with necrotizing fasciitis and 84 control patients). Based on the calculated probability we stratified patients with soft tissue infections into 3 risks categories: high (LRINEC score _8), intermediate (LRINEC score 6–7) and low (LRINEC score _ 5) risks groups.

The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. On admission, patients in the intermediate and especially the high risks groups should be subjected to a frozen section biopsy or MRI scans with an aim of early diagnosis, debridement and ultimately